Getting to the roots of health inequality

The Coalition's budget forecasts a surplus that could already have been achieved if they weren't turning back time to deliver tax cuts for this financial year. If going full speed ahead to a surplus wasn't essential to this budget, why couldn't they better fund critical health issues? A strong economy is the cornerstone of the budget, but it is hard to see how this can be achieved when there are so many weak points in the health system.

Budget 2019-20 promised lower taxes, a guarantee for essential services and an investment in community. However, the slated expenditure seems to demonstrate that a PR campaign on border security is worth far more than tackling the worst social problem in the country — Indigenous youth suicide.

Almost half of Australia's child suicides have been of First Nations children, and of child suicides aged 14 years and less, nearly 90 per cent this year have been First Nations. Yet this national crisis received only $5 million of federal funding — from a total $160 million investment for Indigenous health — while $185 million was spent on reopening Christmas Island for the purpose of deterring people smugglers.

In the worst area for Indigenous youth suicide, the Kimberley, community-driven action plans worth $130,000 each will run in seven communities. In contrast, $3 million has been provided for Home Affairs to 'reinforce' the Operation Sovereign Borders communications campaign, as if the renewal of the facility wasn't already an expensive political message in itself.

Of course, expenditure on the Christmas Island facility doesn't even address the health needs raised by the passage of the Medevac bill. This life-saving legislation was delayed by the government over the Christmas period.

Since receiving royal assent this year, only one person has been transferred to mainland Australia. This is despite relentless government rhetoric that we would be 'swamped' by refugees. Only a couple of months ago independent MP Kerryn Phelps, who is the former president of the Australian Medical Association, said that of the 1000 people on Manus and Nauru, about 70 required urgent assistance and 100 would need help soon.

In total, the government has invested an additional $461 million in youth mental health and suicide prevention, but there is still a schism in funding for services for acute and chronic issues. Honor Eastly, in her podcast No Feeling is Final, described this phenomenon as 'the vast wasteland' — the gap through which people with mental illness fall when they need more than a mental health plan but do not qualify to check into psych ward.

"A universal dental scheme with no out of pocket expenses would cost government $5.6 billion per year but would drastically improve health outcomes and equity for all Australians."

Headspace, who receive $111.3 million to open more centres, are an invaluable organisation whose services are bulk billed under Medicare, but they cater only to those aged 12-25. And there are still big out of pocket costs and waiting times for those seeing psychologists on a mental health plan — which only offers a partial subsidy on appointments. Meanwhile, in regional and rural towns, getting an appointment with a psychiatrist can take months and require patients to travel long distances and pay high fees.

The $54 million to establish four specialist residential facilities for those with eating disorders is a great initiative but more still needs to be done to prioritise treatment for mental health at all stages. While better access has been the goal, assisting Australians with acute mental health issues onto the NDIS could ensure more comprehensive care for those with a psychosocial disability. The scheme is already underfunded and prioritising the expansion and quality should be core government business, rather than dog whistling about refugees.

Meanwhile, Labor has focused its pitch on removing out of pocket costs for cancer care with a $2.3 billion package, which demonstrates a strong vision for a healthy and fair society. This is undoubtedly a positive policy, with cancer affecting one in two Australians and touching the lives of many more. Labor has also promised to roll out more mental health facilities away from the major cities. However, Labor could go further with its health platform of funding specialist care by finally sinking its teeth into putting dental for all on Medicare.

Two million Australians avoid or delay going to the dentist every year, according to research by the Grattan Institute. This has severe health implications and costs for the system. A universal dental scheme with no out of pocket expenses would cost government $5.6 billion per year but would drastically improve health outcomes and equity for all Australians. Currently children receive full or partial payments for their check-ups, while most states offer different levels of subsidies, co-payments and emergency cover for seniors, pensioners, and refugees.

Poor oral health can be a risk factor for heart disease, stroke and diabetes. Ensuring all Australians can afford to see a dentist before ending up in emergency is a big spend but it makes good economic sense. It would lessen the burden on taxpayers of costly crisis procedures and prevent loss of productivity from recovery time.

Without addressing these holes in funding for specialist health, especially those for the most vulnerable in society, we are far from providing a fair go for all.

Eliza Berlage is a Canberra based journalist and podcast producer with a background in sociology. She currently works in the Parliament House press gallery as a researcher for The Conversation's chief political correspondent Michelle Grattan.

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1. No amount of money will compensate for absent or appalling parenting which leaves a poor child with nothing to look forward to or live for.
2. The taxpayer will have to be prepared to cop a huge increase in the compulsory levy for Medicare to accommodate the outrageous fees charged by the fang farriers. [The fee for a crown on a front tooth to preserve appearance is four times or more (depending on the dentist's level of greed) the fee for a kidney transplant to save a child's life! Now there's health inequality to contemplate.john frawley | 09 April 2019

A really excellent analysis the like of which we rarely see in mainstream media. The other gaping hole in the health system is the public hospitals, at least in Queensland overwhelmed by demand as people exit the private health system. And this is without any unforeseen crisis like a true flu epidemic. All the efficiency tweaks have been done to cut length of stay: it is a matter of getting more resources. Uncontrolled doctors gap fees, and health fund subscription rises consistently exceeding inflation and wages will make private care increasingly unaffordable. Llewellyn Davies | 11 April 2019